Ealing Hospital Newapproachcomprehensive Report

London North West Healthcare NHS Trust Ealing Hospital Quality Report Ealing Hospital Uxbridge Road Southall Middlesex Date of inspection visit: 19 - 23 October 2015; UB1 3HW unannounced inspections between 3 - 7 November Tel: 020 8967 5000 2015 Website: www.lnwh.nhs.uk Date of publication: 21/06/2016 This report describes our judgement of the quality of care at this hospital. It is based on a combination of what we found when we inspected, information from our ‘Intelligent Monitoring’ system, and information given to us from patients, the public and other organisations. Ratings Overall rating for this hospital Requires improvement ––– Urgent and emergency services Requires improvement ––– Medical care (including older people’s care) Requires improvement ––– Surgery Requires improvement ––– Critical care Good ––– Services for children and young people Requires improvement ––– End of life care Good ––– Outpatients and diagnostic imaging Good ––– 1 Ealing Hospital Quality Report 21/06/2016 Summary of findings Letter from the Chief Inspector of Hospitals Ealing Hospital is part of London North West Healthcare NHS Trust, which is one of the largest integrated care trusts in the country, bringing together hospital and community services across Brent, Ealing and Harrow. Established on 1 October 2014 from the merger of North West London NHS Trust and Ealing Hospitals NHS Trust, and employing more than 8,000 staff it serves a diverse population of approximately 850,000. The trust runs Northwick Park Hospital, St Mark’s Hospital, Harrow; Central Middlesex Hospital in Park Royal and Ealing Hospital in Southall. It also runs 4 community hospitals – Clayponds Rehabilitation Hospital, Meadow House Hospital, Denham unit and Willesden Centre - in addition to providing community health services in the London Boroughs of Brent, Ealing and Harrow. At the end of the financial year 2014-15 the trust had a deficit of £55.9 million. We carried out this inspection as part of our comprehensive acute hospital inspection programme for combined acute hospital and community health based trusts. We inspected Northwick Park Hospital, Ealing Hospital and the following community health services: community services for adults; community services for children, young people and families; community inpatient services; community services for end of life care and community dental services. The announced part of the inspection took place between 19-23 October 2015 and there were further unannounced inspections which took place between 3-7 November 2015. Overall we rated this hospital as requires improvement. We rated critical care, end of life care and outpatients and diagnostic services as good. We rated the following acute services provided by the hospital as requires improvement: Urgent and emergency care, medical care including care of the elderly, surgery, and services for children. and end of life care. Our key findings were as follows: • The merger of the trust had been protracted and subject to delay. This had had a negative effect on performance and leadership. • We saw overall disappointing progress in merging systems and processes at the trust. To most intents and purposes Ealing and Northwick Park appeared to be operating as separate entities and community health services appeared disengaged from the rest of the trust. • There appeared to be substantial duplication of support functions at both main sites. There appeared to have been lack of control over spend of administrative, non-staff, and nursing staffing budgets with little rationale over nursing numbers on wards. • A new chief executive had recently been appointed earlier in 2015. She was in the process of building a new executive team and by the time of our inspection only one member of the previous substantive executive team was in post. This meant that the new executive team were in the process of getting to grips with their respective functions. • All staff working at the hospital were dedicated, caring and supportive of each other within their ward and locality. There was a high degree of anxiety and uncertainty borne out of the merger and also fears of service removal and potential job losses particularly at Ealing Hospital. • There appeared to be a lack of firm information provided to staff about the effects of Shaping a Healthier Future - to reconfigure services in north west London - despite the chief executive holding regular briefing session. This added to staff anxieties, particularly at Ealing. • We saw several areas of good practice or progress including: • a good service overall for end of life care particularly at Ealing and in the community health service. • caring attitudes, dedication and good multi-disciplinary teamwork of clinical staff. 2 Ealing Hospital Quality Report 21/06/2016 Summary of findings • good partnership working between urgent and emergency care staff and London Ambulance staff. • good induction training for junior doctors. • research projects into falls bundles, stroke trials and good cross site working in research. • Staff told us there were good opportunities for training and career development. • We found the specialist palliative care team (SPCT) to be passionate about ensuring patients and people close to them received safe, effective and good quality care in a timely manner. • The play specialists in services for children demonstrated how they could make a difference to the service and its environment in meeting the needs of the children and young people. This included an outstanding diversional therapy approach for children and young people, which was led by the play specialist and school tutor. • evidence of good antibiotic stewardship, particularly at Ealing pharmacy, with regular reviews of need; and the roll out of drug cabinets across certain parts of the trust with secure finger print access. • patient satisfaction data collected by iPAD by Ealing pharmacy. However, there were also areas of poor practice where the trust needs to make improvements including the following: • The performance dashboards for ED showed that compliance with achieving the mandatory targets, including the 4 hour treatment target, had been poor over the previous 12 months. Performance at Ealing had dropped since the merger. • The emergency department participated and performed poorly in the College of Emergency Medicine audits on pain relief, renal colic, fractured neck of femur and consultant sign-off; and there were no clear action plans drawn up by the department indicating what actions were taken as a result of the audits. • Compliance with safeguarding training was poor particularly among medical and dental staff. • The trust target was to have 95% of staff having completed mandatory training. Trust data, as of March 2014 – July 2015, showed compliance with the target was poor in many areas. • We saw examples of poor infection control practice such as linen left on a bin when a nurse was putting gloves on, staff wearing nose rings and hooped earrings that were not covered and name badges that were made of paper. • In surgery, several groups of patients had no formally defined pathway, which impacted on their safety. • The National Bowel Cancer Audit for 2014 indicated that data completeness for patients having major surgery was poor at 30%, compared with an England average of 87%. • There was a lack of formal escalation process for surgical patients who deteriorated on eHDU aside from the support provided by the outreach team. • Staff on wards outside of the end of life team had a poor understanding of end of life care and the trust LDLCA - Last days of life care agreement. Concern was raised that doctors and nurses on the wards did not recognise deteriorating and dying patients. • Signage for outpatient clinics was in some cases poor and or stopped short of providing clear directions for patients. • At Ealing ED we had some concerns around the care and treatment of children. There were insufficient children’s nurses employed to ensure they were consistently available at all times. Not all adult-trained staff had been trained in paediatric life support. • There were some aspects of poor morale of staff on the medical wards at Ealing. • There were some concerns with cleanliness and the state of repair or servicing of equipment and fixtures on medical wards at Ealing. • Audits showed hand hygiene was a concern with some wards either not submitting audits or scoring less than 90%. • We had concerns with medicines given by night staff. Drug rounds were arranged so night staff had a round at the start and two at the end of their shift with a potential increased risk of error. • All types of therapy visits on wards were unscheduled meaning patients could miss their therapy if they were away from their bed or in pain. 3 Ealing Hospital Quality Report 21/06/2016 Summary of findings • We were concerned at the lack of provision for dementia care and inconsistent assessment of patients failing to direct them to a dementia friendly wards at Ealing. However, patients living with dementia were not specifically triaged to be admitted to this ward and some aspects of the ward were not dementia friendly. • In surgery at Ealing there was inadequate stock of some “bread and butter” items of equipment, such as endoscopic gastro-intestinal cartridges. Sets came back from the decontamination unit incomplete. • At Ealing OPD, the outpatients risk register identified five issues of concern including lack of capacity, temperature in the women’s clinic environment, lack of availability

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